Anesthesie generale pour cesarienne au Chu Sylvanus Olympio de Lome (Togo): indications et complications perioperatoires

Objectif: repertorier les indications justifiant des anesthesies generales (AG) pour cesariennes au CHU Sylvanus Olympio (CHU SO) de Lome et relever la morbidite et la mortalite associees. Cadre et methode: etude prospective et observationnelle sur une periode de 7 mois, allant du 1 ier octobre 2015 au 31 mars 2016, dans le service de Gynecologie et d’Obstetrique du CHU SO de Lome. Toutes les parturientes cesarisees sous AG etaient incluses dans l’etude. Les parametres etudies etaient : l’âge, le sexe, les donnees obstetricales, les donnees anesthesiologiques, les complications, et les deces. Resultats: durant la periode d’etude, 195 parturientes ont ete cesarisees sous AG representant 7% de toutes les cesariennes. L’âge moyen des parturientes etait de 29±4,4 ans. Toutes ces patientes cesarisees sous AG etaient prises en charge dans un contexte d’urgence. Les indications de ces cesariennes sous AG etaient representees par des eclampsies : 96 (49,2%) cas, des procidences du cordon battant : 75 (38,5%) cas, des placentas praevia hemorragiques (PPH) : 18 (9,2%) cas, des souffrances foetales aigues (SFA) : 6 (3,1%) cas. La classification ASA etait la suivante : ASA 1+U : 26 (13,3%), ASA 2+ U : 72 (36,9%), ASA 3+U : 102 (61,5%). Des complications essentiellement respiratoires : 27 (13,8%), cardiovasculaires 47(24,1%) dont 7 arrets cardio-circulatoires, neurologiques 55(28,2%) sont survenues en perioperatoire. Cinq deces ont ete enregistres (taux : 2,56%), tous en postoperatoire. Trois par eclampsie et 2 par choc hemorragique compliquant un PPH. Conclusion: Les indications de l’AG pour cesarienne etaient representees par les urgences immediates. La grande morbidite et mortalite observee etaient en rapport avec les pathologies gravidiques hemorragiques et neurologiques. Mots cles: Anesthesie generale-Cesarienne-CHU-Togo English Title:  General anesthesia for cesarian at Sylvanus Olympio Teaching Hospital of Lome (Togo): perioperative indications and complications English Abstract Objective: To list the indications and the perioperative complications pertaining to general anesthesia (GA) for cesarean section at the Sylvanus Olympio Teaching Hospital (CHU SO) of Lome. Method: Prospective and observational study over a period of 7 months, from October 1, 2015 to March 31 st , 2016, in the gynecology and obstetrics department of CHU SO of Lome. All parturient operated under GA were included to the study. The parameters studied were: age, sex, obstetrical data, anesthesiological data, complications and deaths. Results: During the study period, 195 parturients had cesarean section under GA, representing 7% of all caesarean sections. The average age of parturients was 29 ± 4.4 years. All parturients having cesarean section under GA were cared for in an emergency context. The indications for these Caesarean sections were represented by eclampsia: 96 (49.2%) cases, beating cord prolapse: 75 (38.5%) cases, hemorrhagic placenta praevia: 18 (9.2 %) cases, acute fetal distress: 6 (3.1 %) cases. ASA physical status classification was as follows: ASA 1 + E: 26 (13.3%), ASA 2+ E: 72 (36.9%), ASA 3 + E: 102 (61.5%). Essentially respiratory complications: 27 (13.8%) cases, cardiovascular: 47 (24.1%) cases, including 7 cardiac arrests, neurological: 55 (28.2%) cases occurred. Five deaths were recorded (rate: 2.56%), all postoperatively. Three patients died of eclampsia and two of hemorrhagic shock complicating hemorrhagic placenta praevia. Conclusion: The indications of GA for cesarean section were represented by immediate emergencies. The great morbidity and mortality observed were related to the hemorrhagic and neurological pregnancy pathologies. Keywords: General anesthesia-Caesarean section-CHU-Togo